High-grade blunt traumatic rupture of kidney transplant: is conservative management an option?

Road traffic accidents are the most common cause of blunt native kidney injuries. Transplanted kidneys are more exposed to such injuries due to the common positioning in the iliac fossa compared with the relatively protected position of the native kidneys. The small number of cases identified in the literature describe grade II and III transplant kidney injuries that were treated surgically. In our case a grade IV injury was managed conservatively giving the necessary time to appropriately plan the future renal replacement therapy options for the patient.

Prostheses designed for vertebral body replacement.

Prostheses are proposed to restore the spinal stability of patients suffering from metastatic malignant tumours in their vertebral bodies. They are designed to replace only one vertebral body and two neighbouring intervertebral discs of the spine. Experiments performed on cervical, thoracic and lumbar sections, which were obtained from fresh cadavers, have shown that the reduction in average compressive strengths of these regions due to the placement of prostheses is about 9%. This seems acceptable for those patients in performing their daily activities. The same amount of reduction has also been observed in average compressive strengths of the neighbouring healthy vertebrae due to the placement of prosthesis heads by bone cement. Developed prostheses have a number of advantages over the existing fusion constructs for the cases considered in this work.

Transcutaneous bilirubin measurement in evaluating neonatal jaundice among Saudi newborns.

Transcutaneous bilirubin measurements, using the Minolta transcutaneous bilirubinometer (TcB), were performed in 68 full-term, healthy Saudi infants. Infants who had exchange transfusion and those under phototherapy were excluded. One hundred and twenty measurements were obtained and compared with serum bilirubin levels measured by the American Optics (A.O.) bilirubinometer. The serum bilirubin range was 3.8-18.4 mg/dl. The results showed that the TcB index correlates well with the serum bilirubin measurement: the regression analysis was: r = 0.878, y = 10.78 + 0.909 x, P less than 0.001. However, the regression line showed that at a serum bilirubin level above 12.9 mg/dl the sensitivity of the TcB was 69% and the specificity 92%, while its positive and negative predictive values were 58% and 95% respectively. There was a fair amount of variability around the regression line which may lead to significant errors in clinical decision-making. Thus, the TcB at present has grave limitations which restrict its usefulness in the newborn.

25-Hydroxyvitamin D and total calcium: extraordinarily low plasma concentrations in Saudi mothers and their neonates.

Venous blood was obtained from 100 consecutive and unselected Saudi Arabian mothers and their neonates within 48 h after delivery. Plasma levels of 25-hydroxyvitamin D (25-OHD) and total calcium were measured in paired samples. Fifty-nine mothers and 70 neonates had subnormal (less than 10 ng/ml) 25-OHD levels. Plasma Ca concentrations were low in 61% of the mothers and 59% of the newborns consisting of 10 preterm and 38 full term babies. There were significant correlation between the plasma levels of maternal and neonatal 25-OHD (r = 0.54; P = 0.0001), maternal 25-OHD and Ca (r = -0.22; P = 0.03), neonatal 25-OHD and Ca (r = -0.28; P = 0.0009), and maternal and neonatal calcium levels (r = 0.46; P = 0.0001). Nevertheless, maternal 25-OHD was not invariably higher than that in the infant. Normocalcemia was observed in 29 neonates and 26 mothers (20 mother/baby pairs) in the presence of subnormal maternal 25-OHD. Twenty babies and 16 mothers including nine mother/baby pairs had hypocalcemia in the presence of normal levels of 25-OHD. This indicates that vitamin D plays a crucial, but not exclusive, role in calcium homeostasis during pregnancy. This study revealed that vitamin D deficiency is very prevalent during pregnancy in Saudi Arabia. It also showed that asymptomatic hypocalcemia in full term babies is far commoner than is generally appreciated. It is considered that vitamin D deficiency is primarily due to lack of exposure to sunlight. Encouragement to obtain sunlight exposure and fortification of food are the only alternative measures.